MEDICARE: THE GROUNDED SOUL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1578498473
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE GROUNDED SOUL LLC

Provider Business Mailing Address
First Line	:	333 W DRAKE RD STE 270
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-6319
Country	:	US
Telephone Number	:	765-398-4645
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 W DRAKE RD STE 270
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-6319
Country	:	US
Telephone Number	:	765-398-4645
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RY SHAVLIK
Credential	:
Telephone Number	:	765-398-4645

Provider Enumeration Date	:	06/15/2026
Last Update Date	:	06/15/2026

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Directions to “THE GROUNDED SOUL LLC ” Practice Location

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